A dissertation presented in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Technikon Natal, 1999. / The paucity of clinical research into the efficacy and effects of the different treatment protocols available for cervical facet syndrome has led to a continued variation in standard care for this condition. The aim of this study was to determine the relative effectiveness of spinal manipulative therapy in conjunction with the administration of a nonsteroidal antiinflammatory drug (NSAID) versus spinal manipulative therapy in conjunction with the administration of a placebo medication in the treatment of cervical facet syndrome. It was hypothesised that treatment with spinal manipulative therapy and NSAIDs over a two week period, with a further four week follow-up period, would be more effective than spinal manipulative therapy and placebo medication in terms of the objective and subjective clinical findings. The study design chosen was that of a double-blind, comparative, clinical trial. Thirty consecutive patients diagnosed with cervical facet syndrome were randomly assigned either to the manipulation and NSAID group or the manipulation and placebo group. The age range of the patients extended from nineteen to fifty-three years. Forty percent of patient occupations in both groups involved work on a computer. Each patient in the NSAID group received 139.5mg of diclofenac free acid a day over five days. The placebo group received the same dosage of similar appearance and taste over the same period. Each group of fifteen patients received treatment three times a week for two weeks. After a follow-up period of four weeks the patients were re-assessed. The patients were assessed by means of obtaining subjective information consisting of three questionnaires: the McGill Short-Form Pain Questionnaire, the Numerical Pain / M

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Technikon Natal, 2000. / Purpose. Patellofemoral pain syndrome (PFPS) refers to a syndrome associated with the following signs and symptoms: anterior knee pain, inflammation, imbalance, instability, or any combination thereof (Wood 1998). The purpose of this investigation was to evaluate whether spinal manipulation, as an adjunct to patella mobilization, contributed significantly to the improvement of patients diagnosed with PFPS. A prospective trial using convenient sampling was implemented using the first 60 volunteers that met the requirements. These were randomly divided into two groups. Participants in group 2 received combined patella mobilization and spinal manipulative therapy, while those in group 1 received patella mobilization only. Each patient selected for the study was required to complete an informed consent form. The selected patients underwent a general medical case history, lower back and knee orthopaedic regional examinations. 8 clinical experiments were done: pain threshold (ALGI), pain tolerance (ALG2), the mean least pain experienced (NRS 1), the mean worst pain experienced (NRS2), the mean pain experienced (NRS3), pain quality (McGill), patellofemoral joint evaluation scale (PFJE) and a patient specific functional scale (PSFS). All were continuous variables except McGill, which was a categorical variable. For each clinical experiment, readings were taken 3 times, i.e. at the first, third and sixth consultations / M

A dissertation presented in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban Institute of Technology, 2002. / Waddell (2000) describes low back pain as a 20th century medical disaster as, despite the efforts, skills and resources available today, the management of simple backache has not reduced the rate of chronic back pain and disability. Foster (1989: 9) indicates that as many as 60-80% of the general population experience LBP during adult life, with between 12-35% suffering from it at anyone time. Waddell (2000: 301) states that while 90% of acute or recurrent attacks settle within 6 weeks, 60% of people have at least one re-occurrence within the next year. Swenson (1998: 108) estimates that mechanical disorders of the spine represent at least 98% of LBP cause. Waddell (2000: 305) believes the aim of primary management is to provide symptomatic control of pain and prevention of disability. A large number of therapeutic options may be considered to provide symptomatic relief however, there is no good, scientific evidence that these options produce lasting benefits or that they change the natural history of back pain. He believes that symptomatic measures are only valuable if they facilitate active exercise and rehabilitation. Waddell (2000: 303) states that there is considerable evidence that manipulation can provide short-term symptomatic benefit in patients with acute back pain without nerve root pain of less than 1 month's duration. Manipulation may be equally effective in dealing with recurrent attacks, however there is limited evidence for the effectiveness of manipulation in patients with chronic LBP and nerve root pain. With the rising popularity of magnetic field diagnostic techniques such as MR! (magnetic resonance imaging), magnets and electrical devices are beginning to gain mainstream medical. / M

A dissertation submitted in partial compliance with the requirements for the Masters Degree in Technology: Chiropractic, Technikon Natal, 1998. / The purpose of this study was to evaluate the relative effectiveness of adjusting the superior vertebral segment as opposed to adjusting the inferior vertebral segment, of the two vertebral motion segments forming the facet joint responsible for the patient's symptoms and resulting in the diagnosis of facet syndrome, in the treatment of mechanical low back pain. Thirty subjects with mechanical low back pain were screened for facet syndrome and randomly divided into two groups of fifteen. Each patient received spinal manipulation for six treatments over 4 weeks, but the contact vertebra was different for each group. In the one group, contact was taken on the superior of the two vertebrae making up the facet syndrome, whereas contact was taken on the inferior of the two involved vertebrae in the second group. In the 'superior' group, the manipulative thrust was directed in the direction of the motion palpation findings, whereas in the 'inferior' group, the manipulative thrust was directed in the opposite direction to the motion palpation findings of the superior segment. Both groups were evaluated in terms of subjective and objective clinical findings by making use of questionnaires (Oswestry Back Pain and Disability Index; Numerical Pain Rating Scale-1 01; Short Form McGill) and goniometer measurements respectively. / M

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Technikon Natal, 1999. / The aim of this placebo-controlled clinical trial was to determine the role of spinal manipulation in the management of irritable bowel syndrome (IBS), in terms of the patients' subjective response to treatment. It was hypothesized that spinal manipulation would have a greater effect than placebo in reducing the intensity of the symptoms of IBS. Thirty subjects diagnosed with IBS were randomly divided into two groups. Each group consisted of 15 subjects, aged between 18 and 50. Patients were treated twice a week for three weeks and once in the fourth week. Thereafter, each patient returned approximately 1 month later to be assessed for any longer-term benefit to treatment. Patients in the experimental group received spinal manipulation directed at areas of spinal fixation, as determined by motion palpation. Patients in the control group were treated using a detuned ultrasound machine over areas of spinal fixation. Treatment was performed with the same degree of enthusiasm in both groups, where possible. / M

A dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Technikon Natal, 2001. / The purpose of this study was to investigate the effectiveness of spinal manipulation compared to passive oscillatory mobilization in order to evaluate the more effective treatment in the management of chronic mechanical thoracic spine pain. It was hypothesized that spinal manipulation and passive oscillatory mobilization would both be effective in the treatment of chronic mechanical thoracic spine pain. It was further postulated that spinal manipulation would be comparatively more effective than passive oscillatory mobilization in terms of objective and subjective clinical findings. This randomised controlled clinical trial consisted of a study population of 60, obtained by convenience sampling. Those patients diagnosed as suffering from chronic mechanical thoracic spine pain were randomly allocated to two groups of 30 each. One group received spinal manipulation and the other group passive oscillatory mobilization on the affected segments. Both groups of patients received 5 treatments over a two-week period. The subjective data was obtained by the use of the short-form McGill Pain Questionnaire and the Numerical Pain Rating Scale-101 Questionnaire. These were filled in by the patient before the first, third and fifth treatments. The objective data was acquired through the use of the algometer. Readings were taken before and after the first, third and fifth treatments. Intra-group analysis of the short-form McGill Pain Questionnaire was done using the Wilcoxon Signed Ranks Test. The paired t-test was used for the Numerical Pain Rating Scale -101 Questionnaire and the Algometer Readings (intra-group analysis). Inter-group analysis of the short-form McGill Pain Questionnaire was done using the Mann Whitney unpaired Utest. The unpaired t-test was used for the Numerical Pain Rating Scale-l 0 I Questionnaire and the Algometer Readings (inter-group analysis). a was set at a 0.05 level of significance. The results were illustrated by means of tables and / M

A dissertation in partial compliance with the requirements for a Master's Degree in Technology in the Department of Chiropractic at Technikon Natal / Cavitation sounds heard during chiropractic adjustments and manipulations to th extension spine are a common phenomena yet their significance is disputed, the mechanism of their production is a matter of speculation, and their origin has never been localized. (Lewit 1978: 4, Grieve 1989; 525) The purpose of this study was to locate the joints which cavitate during the performance of a L5 spinous hook adjustment and a lower sacroiliac adjustment. It was hypothesised that the cavitation sounds would arise from the L4-L5 and L5-S1facets on the side of contact during the L5 hook adjustment., and from the the sacroiliac joint on the side being adjusted during the lower sacroiliac adjustment. It was also hypothesised that the two adjustments would differ significantly in terms of the cavitation sounds produced. Volunteers were screened for agreement with the inclusion criteria. Of these 30 asymptomatic between the ages of 18 and 30 were selected. This was sample was then randomly divided into two groups of, one of which recieved the L5 hook adjustment and the other the lower sacroiliac adjustment. All of the subjects had eight microphones taped to the skin, over the relevant facets and the sacroiliac joints. Radiographic confirmation was used in order to ensure proper positioning of the microphones. The microphones were then connected to filters, amplifiers and a computer which recorded any sound signals registered during the adjustments. / M

Dissertation submitted in partial compliance with the requirements for a Master's Degree in Technology: Chiropratic, Technikon Natal, 2002. / McGregor et al ( 1998) stated that approximately 50 – 80 % of the population in Western society will experience low back pain at some point. According to Cibulka and Koldehoff (1999), the sacroiliac joint is a common cause of low back pain that is overlooked. This study aimed to provide insight into the relative effectiveness of three different approaches in the management of sacroiliac syndrome. Giles and Muller (1999) concluded that spinal manipulative therapy was an effective form of treatment for spinal pain syndromes whilst Burgos et al (2001) states that the use of transcutaneous non-steroidal anti-inflammatories in the management of musculoskeletal conditions is a common therapeutic strategy. This investigation aimed to determine the relative effectiveness of spinal manipulative therapy combined with transcutaneous flurbiprofen (TransAct® patches ) versus spinal manipulative therapy combined with either menthol or non-medicated placebo patches in the management of sacroiliac syndrome, in terms of objective and subjective measures. / M

M.Tech. / OBJECTIVE: The aim of this study was to determine whether adjustment of the cervico-thoracic motion segment in individuals with altered or decreased motion at that segment, in conjunction with a strengthening protocol, had a greater increase in triceps brachii muscle strength compared to a strengthening protocol or chiropractic adjustment alone. By reducing the negative neural and other effects caused by aberrant movement between vertebra, chiropractic adjustment could allow the body’s muscle physiology to function at its best, thereby allowing it to adapt to changes more readily. DESIGN: Thirty subjects participated in this study. The subjects were randomly and without being aware of it, assigned to one of three groups. The only requirement for inclusion in the research was a restriction of the seventh cervical vertebra based on motion and static palpation. Patients in two of the groups were asked to perform tricep brachii muscle strengthening exercises and patients from two of the groups received chiropractic adjustment to the cervico-thoracic motion segment. Patients were seen a total of three times over a period of two weeks. MEASUREMENTS: Triceps brachii muscle strength testing was performed using an isometric dynamometer. Three pre-treatment readings and three post-treatment readings were performed, with one-minute intervals, on all the subjects. This was done to determine if there was a change before or after treatment and if there was a long-term effect. CONCLUSION: Although measurements were taken on each visit before and after each treatment, there was only a statistically significant difference in triceps brachii muscle strength between the experimental and the other two groups before treatment on the third visit. This does however; suggest that there was a favourable result and that a combination of treatments does indeed produce better results than one of the other treatments alone.

Thesis (M.Tech.: Chiropractic)- Dept. of Chiropractic, Technikon Natal, 2002. 1 v. (various pagings) / McGregor et al ( 1998) stated that approximately 50 – 80 % of the population in Western society will experience low back pain at some point. According to Cibulka and Koldehoff (1999), the sacroiliac joint is a common cause of low back pain that is overlooked. This study aimed to provide insight into the relative effectiveness of three different approaches in the management of sacroiliac syndrome. Giles and Muller (1999) concluded that spinal manipulative therapy was an effective form of treatment for spinal pain syndromes whilst Burgos et al (2001) states that the use of transcutaneous non-steroidal anti-inflammatories in the management of musculoskeletal conditions is a common therapeutic strategy. This investigation aimed to determine the relative effectiveness of spinal manipulative therapy combined with transcutaneous flurbiprofen (TransAct® patches ) versus spinal manipulative therapy combined with either menthol or non-medicated placebo patches in the management of sacroiliac syndrome, in terms of objective and subjective measures.